Risk and complications of IV. Therapy

Risks and Complications of Intravenous

Therapy

Prepared By

Erlie F. Gaspar RN

E.R. Dept. Head Nurse

Objectives

• Differentiate between local and systemic complications.
• Describe the signs and symptoms of local complications.
• Identify prompt treatment for local and systemic complications.
• Identify Standards of nursing practice.
• List three risk factors for phlebitis.
• Identify organisms responsible for septicemia related to infusion therapy.
• Identify prevention techniques for the systemic complications.

Goal

On the part of the health care provider,

one of the most important concern aside from excellence and competency in performing the procedure is safety....

Therefore, the one must have the knowledge and skills to avoid such risks inevitably accompanied by performing the procedure.

On the Client's

Core Concerns

Regarding IVT

I. Safety of the procedure

II. Therapeutic effect of the procedure on client's condition

III. Maximum Possible comfort

Kinds of I.V.Risks and Complications

Local Complications

Systemic Complication

1. Hematoma:

Formations resulting from the infiltration of blood into the tissues at the Venipuncture site.

Signs and Symptoms:

Fever and malaise.

Slowed or stopped infusion rate.

Inability to flush licking device.

Persistent withdrawal occlusion

Partial occlusion

Complete occlusion

Fibrin tail

Fibrin sheath

Mural thrombosis

Patient Care Excellence

and competence

Risks associated with IVT

I. Needle stick injury

-Percutaneous piercing of wound typically set by a needle or any other sharp object/instrument.

Are such complications occuring at a confined, particular and specific organ or body part.

II. Infectious organism exposure

Thrombosis

Types of Thrombus or occlusion

8. Venous spasm

Causes:

Rupture the vein during an unsuccessful

Venipuncture attempt.

Discontinuing the I.V. cannula or needle without

pressure.

Applying a tourniquet too tightly above a

previously attempted Venipuncture site.

Signs/symptoms:

Discoloration of the skin.

Site swelling and discomfort.

Inability to advance the cannula all the

way into the vein during insertion.

Resistance to positive pressure during

the lick flushing procedure.

A sudden involuntary contraction of a vein or an artery resulting in temporary cessation of blood flow through a vessel.

Signs/symptoms:

sharp pain at the IV site that travels up the arm, which is caused by acute flow of fluid that irritates the vein wall; slowing of the infusion

2. Thrombosis

Treatment:

Apply direct, light pressure for 2-3 minutes after needle removed

Have patient elevate extremity

Apply Ice

Prevention:

Apply tourniquet just before venipuncture

Use a small needle in the elderly and patients on steriods, or patients with thin skin.

Use blood pressure cuff to apply pressure

Be gentle

-The time from the movement of exposure to an infection.

Trauma to the endothelial cells of the venous wall causes red blood cells to adhere to the vein wall, forms a clot.

Catheter-related obstructions can be categorized as mechanical or non-thrombotic ( 42% of all obstructions)

or thrombotic (58% of all obstructions),

7. Local infection

Prevention

Use pumps and controllers to manage flow rate

Microdrip tubing for rate below 50mL/hr

Avoid areas of flexion

Use filters

Avoid lower extremeties

Microbial contamination of the cannula or infusate

Signs/symptoms:

Redness and swelling at the site; possible

exudates of purulent material.

Increased quantity of white blood cells;

and elevated temperature.

3. Phlebitis

-An inflammation of the vein.

Immune system causes leukocytes to gather at the inflamed site

Redness and tenderness increase

Pyrogens stimulate the hypothalamus to raise body temperature

Pyrogens stimulate bone marrow to release more leukocytes

Mechanical:

Too large catheter for the size of the vein

Manipulation of the catheter: improper stabilization

Chemical: vein becomes inflamed by irritating or vessicant solutions or medication

Irritation medication or solution

Improperly mixed or diluted

Too-rapid infusion

Presence of particulate matter

Nursing Interventions:

Remove IV device.

Apply warm soaks.

Notify primary care provider.

Restart IV infusion in a different extremity.

Document your actions.

The more acidic the IV solution the greater the risk

Additives: Potassium

Type of material

Length of dwell:

30% by day 2, 39-40% by day 3 (Macki and Ringer)

The slower the rate of infusion the less irritation

Prevention

Use larger veins for hypertonic solutions

Central lines for Infusions lasting longer than 5 days

1. Septicemia:

A febrile disease process that results from the presence of microorganisms or their toxic products in the circulatory system.

6. Extravasations

Bacterial

Also called Septic phlebitis: least common

Inflammation of the intima of the vein

Contributing factors

Poor aseptic technique

Failure to detect breaks in the integrity of the equipment

Poor insertion technique

Inadequate stabilization

Failure to perform site assessment

Aseptic preparation of solutions

Hand washing and preparing the skin

Signs/symptoms:

Redness at site.

Site warm to touch and local swelling.

Palpable cord along the vein.

Sluggish infusion rate.

Increase in basal temperature of 1 °C or more.

The accidental administration of a vesicant solution into surrounding tissue.

Vesicant is a fluid or medication that causes the formation of blisters, with subsequent sloughing of tissues occurring from the tissue necrosis

Related Factors:

Puncture of the distal wall

Mechanical friction

Dislodgement of the catheter

Signs and Symptoms:

Fluctuating fever, tremors, little cold sweat, nausea and vomiting, diarrhea, abdominal pain.

Tachycardia, increased respirations or hyperventilation, altered mental status, and hypotension

Phlebitis Postinfusion:

Inflamation of the vein 48-96 hr after discontinued

Factors that contribute:

Insertion technique

Condition of the vein used

Type, compatibility, pH of solution used

Gauge, size, length, and material

Dwell time

Infrequent dressing change

Host factors: age, gender, age

and presence of disease

Septicemia Interventions

Notify physician immediately.

Symptomatic care.

Identify other sources of infection.

Remove IV device.

Culture the IV cannula, tubing, or solution if it is suspect.

Return fluid to pharmacy.

Establish a new IV site for medication or fluid administration.

Prevention

Signs/symptoms:

Complaints of pain or burning; swelling proximal or distal to the IV site.

puffiness of the dependent part of the limb; skin tightness at the Venipuncture site; and coolness of the skin.

Slow or stopped infusion; damp or wet dressing.

• Avoid the use of needles where safe and effective alternatives are available.
• Avoid recapping of needles
• Report all needlestick and other sharps-related injuries to ensure that you received ap't follow-up care.
• create / maintain a safe comprehensive disposal system.

Prevention:

Use of skilled practitioners

Knowledge of vesicants

Condition of the patients veins

Drug administration technique

If continuous give in CVAD

Only with brisk blood return of 3-5 cc

Use of a free flow IV

Do not use a pump on vesicants given peripherally

Assess for blood return frequently

Extravasations Interventions

Stop the infusion, and elevate extremity.

Remove the cannula.

Call physician.

Administer antidote (if appropriate) intradermally into infiltrated tissue.

Apply warm moist compresses for 20 minutes every 4 hours (see hospital policy).

2. Fluid overload & Pulmonary

edema

5. Infiltration

4.Thrombophlebitis

Accidental administration of a non vesicant solution into surrounding tissue.

Dislodgment of the catheter from the vein

Second to phlebitis as a cuase of IV therapy morbidity

Thrombophlebitis denotes a twofold injury: thrombosis and inflammation

Related to:

Use of veins in the lower extremity

Use of hypertonic or highly acidic infusion solutions

Causes similar to those leading to phlebitis

Caused by infusing excessive amounts of isotonic or hypertonic crystalloid solutions to rapidly, failure to monitor the IV infusion or too-rapid infusion of any fluid in a patient compromised by cardiopulmonary or renal disease.

5. Catheter embolism

Prevention of Infiltration

A piece of the catheter breaks off and travels through the vascular system.

S/S: sharp sudden pain at the IV site, minimal blood return, rough and uneven catheter noted on removal, cyanosis, chest pain, tachycardia, hypotension.

Select site over long bone to act as a splint.

Avoid sites over joints.

Use arm board to stabilize (as a last resort!).

Signs/symptoms:

Coolness of skin around site, and tight skin.

Dependent edema and absence of blood backflow.

A pinkish blood return.

Infusion rate slows but the fluid continues to infuse.

Septic thrombophlebits can be prevented:

Appropriate skin preparation

Aseptic technique in the maintance of infusion

Proper hand hygiene

60% from patients skin

35% from the line itself

5% from hands

Signs/symptoms:

Sluggish flow rate, edema in the limbs.

Tender and cordlike vein, site warm to

touch.

Visible red line above Venipuncture site.

Diminished arterial pulses.

Mottling and Cyanosis of the extremities.

S/S:

Restlessness, headache, tachycardia, weight gain over a short period of time, cough, and presence of edema.

Hypertension, wide variance between intake and output, distended neck veins.

Treatment of Infiltration

Prevention

Use veins in the forearm rather than the hands

Do not use veins in a joint

Assess site q 4 hr in adults, q 2 hr in children

Catheter securment

Infuse at rate prescribed

Use the smallest size catheter to do the job

Proper dilution

Discontinue the infusion.

Apply warm, moist heat to ↓edema.

Elevate the extremity.

Restart the infusion at another site, preferable the other arm.

• Do proper hand hygiene
• Do not reuse tourniquets
• Wear gloves
• Cleanse insertion sites w/ the recommended sol'n.

Prevention

4. Speed shock

3. Air embolism

Occurs when a foreign substance usually a medication is rapidly introduced into the circulation

Air entering the central vein, which is quickly trapped in the blood as it flows forward. Prevention is the key.

S/S:

complaints of palpitations, and weakness.

Pulmonary findings: dyspnea, cyanosis, tachypnea, expiratory, wheezes, cough, and pulmonary edema.

Cardiovascular: murmur; weak, thready pulse; tachycardia; substernal chest pain; hypotension; and jugular venous distention.

Neurologic findings: change in mental status, confusion, coma, anxiousness, and seizures.

S/S: dizziness, facial flushing, headache, tightness in the chest, hypotension, irregular pulse, progression of shock.

Nursing Interventions:

Immediately clamp the tubing.

Turn client to left, head down (to allow air to enter right atrium and be dispersed via pulmonary artery)

Monitor vital signs.

Administer O2.

Notify physician.

Document actions.

, and treatment.